Validity of Single Tract Microelectrode Recording in Subthalamic Nucleus Stimulation
スポンサーリンク
概要
- 論文の詳細を見る
In surgery for subthalamic nucleus (STN) deep brain stimulation (DBS), precise implantation of the lead into the STN is essential. Physiological refinement with microelectrode recording (MER) is the gold standard for identifying STN. We studied single tract MER findings and surgical outcomes and verified our surgical method using single tract MER. The number of trajectories in MER and the final position of lead placement were retrospectively analyzed in 440 sides of STN DBS in 221 patients. Bilateral STN DBS yielded marked improvement in the motor score, dyskinesia/fluctuation score, and reduced requirement of dopaminergic medication in this series. The number of trajectories required to obtain sufficient activity of the STN was one in 79.0%, two in 18.2%, and three or more in 2.5% of 440 sides. In 92 sides requiring altered trajectory, the final direction of trajectory movement was posterior in 73.9%, anterior in 13.0%, lateral in 5.4%, and medial in 4.3%. In 18 patients, posterior moves were required due to significant brain shift with intracranial air caused by outflow of CSF during the second side procedure. Sufficient STN activity is obtained with minimum trajectories by proper targeting and precise interpretation of MER findings even in the single tract method. Anterior–posterior moves rather than medial–lateral moves should be attempted first in cases with insufficient recording of STN activity.
著者
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Hattori Nobutaka
Department of Neurology, Juntendo University School of Medicine
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Oka Yuichi
Department Of Materials Science Graduate School Of Engineering Hokkaido University
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Umemura Atsushi
Department Of Neurosurgery Hamamatsu Social Insurance Hospital
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Hattori Nobutaka
Department Of Neurology Juntendo University School Of Medicine
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Yamada Kazuo
Department Of Architecture Faculty Of Engineering Aichi Institute Of Technoligy
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YAMADA Kazuo
Department of Neurosurgery, Nagoya City University Graduate School of Medicine
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OYAMA Genko
Department of Research and Therapeutics for Movement Disorders, Juntendo University School of Medicine
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SHIMO Yasushi
Department of Research and Therapeutics for Movement Disorders, Juntendo University School of Medicine
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Yamada Kazuo
Department of Applied Molecular Chemistry, College of Industrial Technology, Nihon University
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UMEMURA Atsushi
Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital
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